Oral lichen planus (OLP) is a chronic inflammatory disease that affects the mucus membrane of the oral cavity. It is a T-cell mediated autoimmune disease in which the cytotoxic CD8+ T cells trigger apoptosis of the basal cells of the oral epithelium. Several antigen-specific and nonspecific inflammatory mechanisms have been put forward to explain the accumulation and homing of CD8+ T cells subepithelially and the subsequent keratinocyte apoptosis. A wide spectrum of treatment modalities is available, from topical corticosteroids to laser ablation of the lesion. In this review, we discuss the various concepts in the pathogenesis and current treatment modalities of OLP.

Background: Premalignant/potentially malignant-oral lesions and conditions such as oral submucous fibrosis are known to transform into oral cancer. The malignant transformation is often associated with changes at the genetic level that in turn is reflected by the altered expression of proteins related to cell cycle, proliferation, and apoptosis. Aim: To evaluate the expression of p53, Ki67 (MIB), bcl2, and bax in oral submucous fibrosis and oral squamous cell carcinoma. Materials and Methods: To assess the immunohistochemical expression of p53, Ki67 (MIB), bcl2, and bax in 50 cases of oral submucous fibrosis (OSF) and ten each of normal and oral squamous cell carcinoma (OSCC). Results: The labeling indices (LI) of OSF and OSCC were comparable for p53 and Ki67.The p53 LI ranged from 7.9 to 71.9 in OSF and 65.2 to 85.9 in OSCC, and for Ki67 it ranged from 4.39 to 43.23, 18.35 to 42.33, respectively. Conclusion: The p53, Ki67, and bax profiles of OSF and OSCC were altered compared to the normal and these markers could be used as surrogate markers of malignant transformation in OSF.

A study to evaluate the efficacy of xylene-free hematoxylin and eosin staining procedure as compared to the conventional hematoxylin and eosin staining: An experimental studyMadhuri R Ankle, Priya S JoshiMay-August 2011, 15(2):161-167DOI:10.4103/0973-029X.84482

Context: Use of diluted dish washing solution (DWS) has been experimented successfully as a substitute for xylene to deparaffinize tissue sections during hematoxylin and eosin (H and E) staining. Aims: (1) Test the hypothesis that xylene- and methanol-free sections (XMF) deparaffinized with diluted DWS are better than or at par with conventional H and E sections. (2) To compare the efficacy of xylene-free sections with the conventional H and E sections. Settings and Design: Single blinded experimental study. Materials and Methods: Sixty paraffin blocks were considered. One section was stained with conventional H and E method (Group A) and the other with XMF H and E (Group B). Slides were scored for parameters; nuclear staining, cytoplasmic staining (adequate = score1, inadequate = score0), uniformity, clarity, crispness (present = score1, absent = score0). Score >/= 2 was inadequate for diagnosis and 3-5 was adequate for diagnosis. Statistical analysis used: Z test. Results: Adequate nuclear staining, 96.66% sections in group A and 98.33% in Group B (Z = 0.59, P>0.05); adequate cytoplasmic staining, 93.33% in group A and 83.33% in Group B (Z = 1.97, P<0.05); uniform staining, 70% in group A, 50% in group B (Z = 1.94, P<0.05), clarity present in 85% of group A, 88.33% of group B sections (Z = 0.27, P>0.05), crisp staining in 76.66% in group A and 83.33% in Group B (Z = 1.98, P<0.05), 88.33% Group A sections stained adequately for diagnosis as compared with 90% in Group B (Z = 0.17, P>0.05). Conclusion: Xylene- and methanol-free H and E staining is a better alternative to the conventional H and E staining procedure.

Basaloid squamous cell carcinoma (BSCC) is a rare distinct histologic variant of squamous - cell carcinoma of the head and neck region. BSCC is more aggressive and has a poorer prognosis, although histologically, it is associated with squamous cell carcinoma and squamous atypia. The usual site of occurrence for BSCC is the upper aerodigestive tract, floor of the mouth and base of the tongue. This is a case report of an unusual case of BSCC of retromolar trigone, which is quite rare.

Unicystic ameloblastoma refers to those cystic lesions that show clinical, radiographic or gross features of a jaw cyst but on histologic examination show a typical ameloblastomatous epithelium lining the cyst cavity, with or without luminal and/or mural tumor proliferation unicystic ameloblastoma is a less encountered variant of the ameloblastoma and believed to be less aggressive. As this tumor shows considerable similarities with dentigerous cysts, both clinically and radiographically the biologic behaviour of this tumor group was reviewed. Moreover, recurrence of unicystic ameloblastoma may be long delayed and a long-term post-operative follow up is essential for proper management of these patients. Here we are presenting a case of unicystic ameloblastoma in a 18 year old female patient.

Epithelial odontogenic tumors arise from odontogenic epithelial structures. Malignant epithelial odontogenic tumors are extremely rare. Ameloblastic carcinomas may present denovo, ex ameloblastoma or ex odontogenic cyst. Most ameloblastic carcinomas are presumed to present denovo. To date less than 45 cases of ameloblastoma with metastasis have been reported. It occurs primarily in the mandible in a wide range of age groups; no sex or race predilection has been noted. It may present as a cystic lesion with benign clinical features or as a large tissue mass with ulceration, significant bone resorption, and tooth mobility. The lesion is usually found unexpectedly after an incisional biopsy or the removal of a cyst. Histologic features of ameloblastic carcinoma shows tumor cells that resemble the cells seen in ameloblastoma, but they show cytologic atypia. Moreover, they lack the characteristic arrangement seen in ameloblastoma. The clinical course of ameloblastic carcinoma is typically aggressive, with extensive local destruction. Here we describe a rare case of ameloblastic carcinoma (secondary dedifferentiated carcinoma) of mandible in a 40-year-old female patient. Ameloblastic carcinoma: Secondary dedifferentiated carcinoma of the mandible.

Background: The purpose of this study was to study the drug sensitivity pattern of Candida seen in HIV seropositive patients in Chennai, South India. Materials and Methods: 36 oral rinse samples were collected from HIV seropositive individuals with (21 patients) and without (15 patients) clinical candidiasis. The type of Candidiasis, quantitative estimation, differentiation of candida species and antifungal susceptibility testing was done using different tests. Results: In the 21 patients with candidiasis, pseudomembranous type predominated with low CD4 counts and high colony forming units. Antifungal Drug sensitivity test revealed resistance to fluconazole which is attributed to long term exposure to the drug. Conclusion: The results of the study confirm the hypothesis that candidal species can be isolated in HIV positive patients with clinical candidiasis. In HIV infection there are fluconazole resistant candida species emerging mainly due to long term exposure to the drug.

Primary neoplasms of the skeleton are rare, accounting for 0.2% of overall human tumor burden. Osteosarcoma (OS) accounts for 15-35% of all primary bone tumors, while gnathic osteosarcomas (GOS) represent 4-8% of all osteosarcomas. GOS shows a predilection for men, a peak incidence of 33 years, and affects the mandible more than the maxilla. We review the scientific literature for a better understanding of the clinical, radiographic, and histopathological features of GOS, along with its etiology, staging, treatment protocol, prognosis, and survival. Evidence from molecular research suggests that it is a differentiation disease that disrupts osteoblasts differentiation from mesenchymal stem cells. The classical radiographic finding of a "sunburst" appearance is appreciated only in 50% of GOS. The universally accepted staging system is not commonly used due to the rarity with which they metastasize to the regional lymph nodes. A number of distinct histopathological subtypes have been described, of which osteoblastic GOS are most common. The treatment protocol is multimodal consisting of preoperative chemotherapy followed by surgery and postoperative chemotherapy, and has a 60-70% five-year survival rate. We present two case reports of osteosarcoma involving the maxillary that were initially misdiagnosed as peripheral giant cell granuloma and osteoma of the maxilla, respectively. These case reports demonstrate the diverse clinical, radiographic, and histopathological features that can be encountered in GOS.

Background: Oral submucous fibrosis is a chronic debilitating disease of oral mucosa and is characterized by generalized fibrosis of the oral soft tissues which tends to present itself clinically as palpable vertical fibrous bands. Hence, this study was conducted to evaluate histopathologically the collagen fiber bundle orientation in relation to epithelium and to find the reason for unidirectional orientation of clinically palpable fibrous bands. Materials and Methods: The study included 33 cases of oral submucous fibrosis and 8 cases of normal tissue. Results: Histologically most of the collagen fibers were parallel to the epithelium, and there was a statistically significant difference in orientation between oral submucous fibrosis and control groups in both buccal mucosa and labial mucosa. Conclusion: The reason for unidirectional alignment of clinical fibrous bands could be due to chronic stimulation of oral mucosa by the irritants leading to change in the orientation of collagen fiber bundles, which might result in scar formation similar to that of wound healing, where the collagen fibers are oriented parallel to the epidermis.

The oral cavity is the site of much infectious and inflammatory disease which has been associated with systemic diseases such as diabetes, cardiovascular disease and pre-term low births. This article emphasizes on the oral-systemic disease connection which is now a rapidly advancing area of research. The possible systemic diseases which arise from oral microorganisms are hereby focused.

The study of gross specimens is an integral part in learning oral pathology. Unfortunately their storage and handling using traditional formalin is discouragingly difficult. This review describes an alternative approach called "plastination" to study and teach gross specimens using silicone polymers. The process is simple, inexpensive, and can be carried out in any histology laboratory to produce dry, odorless, durable, life-like, maintenance-free, and nonhazardous specimens. Unfortunately the process of plastination for oral specimens has received little attention since its invention. Therefore, an innovative attempt on oral specimens using locally available resin was tried by us. The specimens remained well preserved in dry state without any color change. We recommend this process for any oral pathology department for maintaining museum and for both undergraduate and postgraduate training.

Renal cell carcinoma represents 3% of all adult malignant tumors. It occurs more frequently in the fifth and sixth decade of life and in a male-female ratio of 1.5 : 1. Among all the primary tumors that arise below the level of the clavicle, renal cell carcinoma is the third most common neoplasm that metastasizes to the head and neck region, but rarely has it been described as the presenting symptom of this tumor. In 7.5% of the patients with renal cell carcinoma, head and neck metastasis is the presenting complaint. However, only 1% of the patients with renal cell carcinoma have metastases confined only to the head and neck; and a solitary cervical metastatic mass, as in the case of our patient, is rare.It seems that head and neck metastasis of renal cell carcinoma should preferentially be treated with surgical excision because of the associated morbidity and quality-of-life issues. Renal cell carcinoma should be considered in the differential diagnosis of any growing lesion in the head and neck.

Metastatic lesions to the oral region are uncommon and account for approximately 1% of all malignant oral tumors. In 25% of the cases, oral metastases are found to be the first sign of the metastatic spread; and in 23% of the cases, it is the first indication of an undiscovered malignancy at a distant site. Metastases to oral soft tissues are even less frequent than jaw bones. Because of its rarity, the clinical presentation of a metastatic lesion in the oral cavity can be deceiving, leading to a misdiagnosis of a benign process; therefore, in any case where the clinical presentation is unusual, especially in patients with a known malignant disease, a biopsy is mandatory. Here, we are presenting a rare case of multiple secondary tumors in the attached gingiva in an otherwise apparently healthy patient with no other symptoms of the primary tumor. It subsequently led to the diagnosis of Pancoast tumor (bronchoalveolar carcinoma) metastasizing simultaneously to multiple sites in the oral cavity and bilateral adrenal glands.

Cysticercosis is a parasitic infestation caused by the larval stage of Taenia solium. It is common in regions where humans and animals live in close contact, with poor sanitation, and due to consumption of infected meat. The tissues affected are the subcutaneous layers, brain, muscle, heart, liver, lungs, and peritoneum. Oral manifestations are very rare. The most common intra-oral site is the tongue. Here, we present a case in a who sought treatment for an asymptomatic nodule in the upper lip. A gross specimen revealed a cystic cavity containing clear watery fluid and white membranous flecks. The histopathology showed features of cysticercosis.

Oral melanoma (OM) is a rare, malignant neoplasm of melanocytic origin. It accounts for 0.2 - 8% of all melanomas. In contrast to its cutaneous counterpart, OM has poor prognosis, possibly due to late clinical diagnosis, nonexistence of standardized clinical or histopathological grading and anatomical limitation in complete excision of the lesion. For better understanding of the lesion, case reports are still considered to be the source of information. Here we present a case of oral primary melanoma occurring in an uncommon site, the mandibular gingiva, with review of related literature.

In this paper, we present two case reports of myxoglobulosis, in a 24-year-old female and a 40-year-old male patient who came to our hospital with a chief complaint of painless swelling of the lower lip of approximately 6 months duration. A study of two case reports has been given here. In these patients, histological examination of the surgically excised tissue was carried out. Histopathological examination showed an extravasation mucocele with the lumen exhibiting unique globular organizations of mucin surrounded by granulation tissue capsule and lacking an epithelial lining. Our two cases are possibly an analogue of myxoglobulosis, a rare variant of the appendical mucocele. Thus, though rare, the possibility of occurrence of myxoglobulosis in cystic lesions of the lip should be considered. The prognosis is regarded better as compared to the other types of mucoceles with low recurrence rate due to good host response and globular organizations of mucin. However, follow- up of these cases and more such cases is required to confirm the prognosis. The need for study of many such cases to confirm the etiology, pathogenesis and biologic nature of this variant is being felt.

Unicystic ameloblastoma (UCA) is a clinical subtype of ameloblastoma that is considered prognostically different. The purpose of this report is to present a case of UCA showing dual radiographic pattern in a child. A detailed study of the lesion was carried out in an 8 year old female child who presented to our department of oral and maxillofacial pathology. Clinical, radiological and histopathological findings were recorded. In March 2005, a painless swelling in the left side of the mandible was noted, which on radiographic examination showed a unilocular radioluceny enclosing the crown of mandibular left permanent second molar, extending between the left first permanent molar and anterior margin of the ramus. Histopathologic diagnosis was UCA. The lesion was treated by enucleation. The patient returned with recurrence in 2009, at this time the lesion radiographically presented as a multilocular radiolucency with a soap bubble appearance, extending between the anterior border of the ramus and second premolar. Histopathologic diagnosis was UCA. The lesion was treated by segmental resection with immediate reconstruction. Although a number of treatment modalities are available to treat UCA, many factors need to be taken into consideration in the treatment of UCA in children.

The term synovioma was coined by Smith in 1927, and later in 1936 Knox suggested the name synovial sarcoma. It occurs primarily in the paraarticular regions, usually in close association with tendon sheaths, bursae, and joint capsules. On rare occasions it may be seen in areas without any apparent relationship to synovial structures as in parapharyngeal region or the abdominal cavity. The first description of synovial sarcoma in the head and neck region was by Pack and Ariel in 1950. The majority of these tumors seem to take origin from paravertebral connective tissue spaces and manifest as solitary retropharyngeal or parapharyngeal masses near the carotid bifurcation. Synovial sarcoma has been reported in soft palate, tongue, maxillofacial region, angle of mandible, sternoclavicular region, scapular region, and the esophagus. We report a case of 28-year-old male patient with synovial sarcoma in mandibular region with biphasic pattern.

Context: Oral verrucous hyperplasia (OVH) is a premalignant lesion that may transform into an oral cancer. Aims: The present retrospective study was carried out to analyze the clinico-pathological features of verrucous hyperplasia (VH). Materials and Methods: Total 19 diagnosed cases of verrucous hyperplasia were retrospectively analyzed for demographic, clinical and histopathological features including dysplasia. Results: Average age of occurrence of lesion was 4 th decade of life, with male predominance (2:1) and common site of occurrence being buccal mucosa. Clinically it present as verrucous exophytic growth with sharp or blunt projections on surface, which corresponds histologically. Tobacco lime quid placement in buccal vestibule was key etiologic factor. Histopathologicaly 68% cases showed dysplasia out of which moderate dysplasia predominates (42%). Moderately dysplastic cases were found to be associated with mixed habit pattern. Maximum cases were treated with excision. Conclusion: Biopsy specimen comprising of adjacent normal epithelium is key in distinguishing verrucous hyperplasia from verrucous carcinoma. Clinical behavior and recurrence potential needs to be assessed with long term follow up studies.

Background: Histological grading is an important diagnostic tool to predict the clinical and biological behaviour of cancer. Cervical lymph node metastasis indicate poor prognosis of oral cancer. Considering economical status of a third world country, Anneroth's grading system is less expensive, more informative than TNM staging and Broder's grading system. Anneroth's grading system also shows co-relationship with lymph node metastasis. So we are trying to evaluate the Anneroth's grading as a standard one among these three system. Objective: To study the grading of histological malignancy according to Anneroth's classification of biopsy specimens in relation to metastasis in the cervical lymph nodes and comparing the Anneroth's with the other two recognized classifications. Materials and Methods: Fifty(50) patients with oral squamous cell carcinoma was included in the study. Specimen of 35 non-metastatic tumors were compared with 15 metastatic cases. All of the patients were graded to TNM, Broder's and Anneroth's system. TNM is clinical assessment and Broder's is based on only differentiation of cells. On the other hand, six parameters of Anneroth's gives a detail about the morphology of the tumor, invasion criteria in the host tissue and show its correlation with lymph node metastasis. Scoring system of Annearoth's grading indicates demarcation points of worseness of tumor and signifies the possibility of lymph node metastasis. Results: Both Anneroth's(P=0.002) and Broder's grading(P=0.012) have been significant but Anneroth's one is more significant then Broder's. Conclusion: Anneroth's classification can be taken as a standerd diagnostic factor and predictive factor of lymph node metastasis.

The concept of 'fibro-osseous lesions' of bone has evolved over the last several decades and now includes two major entities, viz., fibrous dysplasia and ossifying fibroma, as well as other less common entities such as periapical dysplasia, focal osseous dysplasia, florid osseous dysplasia and familial gigantiform cementoma. Florid osseous dysplasia is a central lesion of the bone and periodontium, which has caused considerable controversy because of confusion regarding terminology and criteria for diagnosis. This paper reports a rare case of florid osseous dysplasia affecting maxilla and mandible bilaterally in a 14-year-old Indian male patient.

The hereditary condition known as ectodermal dysplasia is characterized by the absence or defect of two or more ectodermally derived structures. The most commonly observed forms of ectodermal dysplasia are the hidrotic and hypohidrotic types; discrimination is based on the absence or presence of sweat glands. A case of 8-year-old male child with hypohidrotic ectodermal dysplasia with complete anodontia of primary as well as secondary dentitions is presented. The child had a short stature, low intelligent quotient (I.Q.,), and was underweight. The patient experienced episodes of high fever, was intolerant to heat, and did not sweat. He exhibited smooth and dry skin, sparse light-colored eyebrows. Dental clinicians can be the first to diagnose ectodermal dysplasia due to the absence of teeth.

Primary intraosseous carcinoma (PIOC) is a rare tumor that has been infrequently reported. Some diagnostic criteria have been proposed to consider a lesion as PIOC: (1) absence of ulcer in the oral mucosa overlying the tumor, (2) absence of another primary tumor at the time of diagnosis and for at least 6 months during the follow-up, and (3) histological evidence of squamous cell carcinoma. The etiology is not clear, although odontogenic embryonic origin has been reported. Probably, PIOC derives from the remnants of odontogenic tissue, either the epithelial rests of Malassez or the remnants of the dental lamina.

Background and Objectives : Oral squamous cell carcinoma (OSCC) is one of the most common tobacco-related cancers affecting the Indian population. Various malignancy-grading systems based on different histopathological features have been proposed for OSCC. Due to inherent subjectivity, inter-observer variation and reproducibility of a grading system remains a problem. Grading systems based on nuclear morphometry have been proposed for laryngeal, renal and pharyngeal carcinomas. In this study, an attempt was made to grade oral OSCC based on computer-assisted microscopic evaluation of nuclear features. Our intention was also to evaluate the use of Feulgen stain for studying nuclear features. Materials and Methods: Sections made from buccal mucosa biopsies of normal mucosa as well as different grades OSCC were stained by Feulgen reaction. The nuclear features were evaluated by computer-assisted microscopic image analysis for nuclear area (NA), nuclear perimeter (NP) and nuclear form factor (NF) and correlated with histologic grading of OSCC. Nuclear shape, membrane outline, chromatin clumps, nucleoli, and abnormal mitoses were also evaluated. Results: NA and NP were observed to be significantly increased in OSCC (P < 0.001) when compared with the control group. These values increased in correlation with increasing grades of OSCC. However, NF was found to more in the control group (P < 0.001). Conclusion: It may be concluded from the results that computer-assisted nuclear morphometry is a reliable tool for grading OSCC. A new grading system based on nuclear features for OSCC has been proposed.

Fibroblasts are a major stromal cell type present in human connective tissue maintaining the structural integrity in health. Depending on the situation, location and various conditions, fibroblasts exhibit considerable variation in morphology, size and shape that suggest the existence of discrete cellular subsets. The purpose of this short communication is to provide information regarding the heterogenecity of fibroblasts and its variability in physiological and pathological conditions.